Sprains Around Ankle Sioux City
Our ankles and feet provide a tremendous amount of flexibility and movement. Without their coordinated stabilization, we would be unable to sit, stand, squat, walk, or run. Most of us don’t think twice about how important our ankles are to walking until we have an injury that swells and limits our ability to stand, let alone walk.This tremendous amount of movement does come at the cost of structural stability. Just like our shoulder, we are predisposed to several types of sprains and strains across the joint.
The tibia sits on a rounded dome of the talus bone. This bony structure allows for a tremendous range of flexion, extension, inversion, and eversion. In the body, mobility comes at the price of stability. We try to stabilize the ankle to limit excessive movement with several large ligaments and tendons, which are commonly injured with sprains and strains.
Most people are familiar with an inversion sprain, such as sliding off the curb and twisting the ankle, where the outside of the foot is forced underneath the ankle. We feel a sharp stabbing pain on the outside of the foot, which may swell within minutes. In this case, we commonly sprain the anterior tibiofibular or anterior talofibular ligaments. Inversion sprains are also common and often damage the calcaneofibular ligament and peroneal tendons. These tendons and ligaments on the outside of the ankle are stretched and damaged with inversion sprains.
The tendons and ligaments stretch like a piece of licorice, breaking the structural fibers. Repair is a slow process because of the limited blood supply to the tendons and ligaments. In the meantime, we continue walking on our ankle, which stretches the damaged tissue, further breaking it down. The repair and healing process is a balance of building more fibers than you break in a day. This back-and-forth process often leads to longer recovery periods of weeks or months. Slow healing also predisposes scar tissue formation, which becomes easily damaged with the next inversion sprain.
It is not uncommon for people to say they had an inversion sprain several years ago and then had numerous ones following. It has become easier and easier to sprain that ankle. In addition to the increased scar tissue in the tendons and ligaments, they also lose the strength and stability that help protect against those movements. With weak stabilizer muscles, the body cannot stabilize the ankle as it starts to twist; therefore, the ankle continues to turn, which sprains the ligaments and tendons.
The deltoid limit ligament consists of three smaller ligaments that act together to prevent ankle eversion sprains. Eversion sprains force the ankle in the opposite manner of in inversion, twisting the inside of the foot underneath the ankle. This stretches and damages the stabilizer ligaments on the medial side (inside) of the ankle. These ligaments are also susceptible to poor healing and scar tissue formation. Without proper muscle stabilization and rehabilitation, future eversion sprains are likely to occur.
Achilles Sprains And Ruptures
With forceful dorsiflexion, we can also strain or rupture the Achilles tendon. A complete rupture would snap the tendon in half, while a partially ruptured Achilles results in some of the tendon being torn, but not all of it. More commonly with runners, we see sprains and chronic tendinitis of the Achilles tendon. This is usually due to overuse and running gaits that place excessive amounts of stress on the Achilles. Achilles tendinitis is common when we alter our gaits for another injury or dramatically increase our running mileage. It also occurs when we shift to different running terrains, such as running more rocky trails when we are used to flat canals.
Tibialis Anterior Tendon, Extensor Retinaculum And Joint Capsule Sprains
If we forcefully stretch the ankle into plantar flexion, we can sprain the muscles, tendons, and ligaments on the front of the ankle. The tibialis anterior tendon runs across the top of the ankle and is commonly damaged in this type of injury. Tibialis anterior sprains are also common with repetitive and overuse injuries such as walking, climbing, hiking, and running. It is very common in running when we increase our mileage by more than 10% per week.
A fatigued runner has a tendency to alter his stride and pound the pavement. The extra pounding force travels up the body and jams the joints. The ankle absorbs some of this force, creating damage and sprains in the tibialis anterior and posterior tibialis tendons.
Smaller Muscle And Tendon Sprains
Several tendons stabilize the ankle and keep it from wobbling. These small muscles and tendons can travel across the top of the foot to the toes, inside of the ankle, or outside of the ankle. These tendons become damaged when running and hiking on uneven surfaces. Rocky and uneven surfaces overwork the tendons, creating sprains.
Many times, we feel localized tenderness with specific movements. The pain can be isolated to a very specific location and reproduced whenever we stretch that area or apply direct pressure. Smaller tendon sprains and strains can be successfully treated with ice, rest, and activity modification. In-office treatments are sometimes required in order to accelerate healing and repair for mild sprains that do not heal with home treatment.
During traumatic sprains, we can also cause small fractures or avulsions, where the tip of the bone is broken off. Avulsion sprains are common on the outside of the ankle or base of the foot. In these circumstances, small fractures can pull a piece of bone away. Small avulsion fractures can heal on their own if they are allowed to rest.
Severe avulsion fractures may require surgical intervention to reattach the broken bone back to its proper location. These avulsion fractures are common at the base of the fifth metatarsal bone, where the peroneus brevis tendon insertion pulls the bone away, especially when we suffer a transverse fracture (Jones fracture). These types of injuries can also occur with the phalanges, cuboid bones, and navicular bones. Sesamoid fractures also occur with acute and traumatic impacts.
Plantar Fasciitis (Pain On The Bottom Of The Foot)
Plantar fasciitis is a common sprain to the plantar fascia on the bottom of the foot. It occurs with acute or chronic overuse. Plantar fascia ruptures can be sudden and painful. A sharp and stabbing pain on the bottom of the foot can happen when jumping off an elevated surface or stepping hard on a rock.
Importance Of Treatment And Healing
Small ligaments and tendons are trying to stabilize the ankle and protect it. Both acute traumatic incidents and chronic overuse can damage the muscles, tendons, and ligaments. Treatment involves decreasing pain and inflammation and restoring muscle strength and endurance. Weakness in the foot and ankle often leads to chronic overuse injuries in the future.
In some instances, overcompensating for weakness of the left ankle can cause right knee, hip, or back injuries. Our body is a system of movement, and weakness at the foundation often causes excessive strain being placed on another joint in the body. Maintaining ankle strength, endurance, and flexibility is very important to all athletes and recreational participants. Take care of your feet, and they will take care of you.
Links to specific treatments and injuries around the Ankle and Foot;
Tibialis Anterior Sprains
Posterior Tibialis Sprains
Knee, Ankle and Foot Pain Conditions